My son is afraid of germs and avoids touching things with his hands.

My 13-year-old son is really afraid of germs. He avoids anything that might be dirty. He washes his hands if he touches anything and he uses Kleenex to touch most things. He hides it most of the time but I know he worries a lot. I think it started with the SARS thing a few years ago. Every story of a new infection makes him more worried.

Fear of contamination by germs is a common phobia. If he were just a bit of a clean freak, there is nothing that I would do about it. But it sounds like he is more than just cautious about being clean.

Washing hands several times a day is a good idea. Infection control specialists suggest that we hand wash:

after using the bathroom

before fixing food

before eating

after touching animals

when hands are dirty

more often when someone in the home is sick

However, his germ fear is unreasonable and seems to be interfering with his life. It is wise to help him overcome this fear. Over time, he could become a prisoner in his own home.

The best way to overcome any fear is to be exposed to what we fear and not escape from it. Eventually we realize that it won’t hurt us. Gradual exposure is best. Treatment is easier said than done. Most people avoid exposure to what they fear. When they are exposed, they try to escape. Avoidance and escape only strengthen fear.

Most fears have a “grain of truth”. It is natural to focus on this. The need to wash hands to prevent infection is the “grain of truth” in your son’s fear. Together with your son, make a list of his feared situations. Have him rate each one on a 0-100 scale with 0 being no fear and 100 being terror. Examples might be something like this:

10: touching a wooden chair in my own home with bare hands

20: touching the kitchen counter that I didn’t see washed right before

50: picking up a ball that the dog has had in his mouth

70: getting hands dirty in the garden

80: emptying the garbage from the bathroom or kitchen

100: touching a public bathroom door handle with bare hands

Each person’s list would be different.

It is best to have 15 or so items on the list. They should be spread out across the levels. The list can be changed as the fear changes. Then his task is to work his way up the list from the least feared to the most feared. First he should imagine doing these and imagine not washing his hands for 5-10 minutes.

He can practice saying things to himself like: “I can do this without getting sick.” “Germs are not all bad, they help build my immune system.”

Then, he should start going through the list in actual life without washing his hands for 5 minutes afterward. So, on the list above, he would purposely touch a chair and not wash his hands for at least 5 minutes. When that becomes possible, and it might take 3 or 4 times practicing it, he would do the same with the dog-slobbered ball and so on.

Over time, the goal would be that he not wash his hands at all, for those things that don’t need hand washing. It is not a good idea to wash your hands every time you touch a chair, table or doorknob.

He will likely need your encouragement. It will take several weeks of daily practice. He may have to get help from a mental health professional to get through this.